Medical-malpractice reform is close to reality in Illinois, awaiting only the signature of Gov. Rod Blagojevich.

The Illinois Senate, in a 36-22 vote shortly after midnight, approved a reform package that includes a cap on noneconomic damages, online publication of physician disciplinary histories, standards for expert witnesses and legal protection for physician apologies to patients.

Noneconomic damage awards will be capped at $500,000 in cases against physicians and $1 million in cases against hospitals.

The House approved the bill 68-46 on Monday.

Blagojevich, a Democrat, has indicated he will sign it.

Both the Illinois State Medical Society and the Illinois Hospital Association supported the measure.

State Rep. Mark Beaubien Jr., a Republican, said the bill contains provisions that Republicans have supported for years but that have only recently gained the support of Democrats — especially in southern Illinois counties that have been losing physicians.

Democrats in those counties must be re-elected for the party to maintain its narrow majority in the House.

“This is all about five southern Democratic House members who are under tremendous fire and (state House Speaker Michael Madigan, a Democrat) has to protect them,” Beaubien said.

Under a new proposal, city and county firefighter paramedics could provide preventive care — like checking in to see whether a forgetful diabetic is taking her medicine and eating her meals. Expensive medical costs could be avoided. Paramedics could get needed patient care training, and their departments might even bring in some cash, county officials said.

“The core is that we’ve got a whole army of health care providers who are extremely well-trained, talented, young and aggressive,” said Dr. John Shedd, the county’s medical director. “They’ve got the time, and they know their municipalities and the citizens who would benefit most from this better than anybody.”

The boarder phenomenon arises because there are not enough hospital beds and nursing staff to accommodate all the patients who need to be admitted on an emergency basis. Financial incentives reward hospitals for keeping their beds full, which favors patients scheduled for elective procedures. As a result, few empty beds are available for ER patients. Besides, Medicare pays hospitals more for taking care of a patient who has elective surgery than a patient like Rowe, who has a medical emergency. So there is built-in financial resistance to admitting many patients from the ER.

Yet, boarding is hazardous to health and it increases costs. Last week at the annual meeting of the Society for Academic Emergency Medicine in New York, researchers presented a study of 50,322 patients from 120 hospitals who were admitted to the ICU from the ER over a three-year period. Boarding in the ER for more than six hours led to increased mortality in the ICU and on the medical floor, longer hospital stays and higher than expected costs.

There are several ways of searching the medical literature. Previously I used PubMed, the interface from the National Library of Medicine. I’ve recently switched to Google Scholar, which has these advantages:

Papers are listed not in order of publication, but in order of relevance, which is determined by PageRank, the same system used in regular Google searches.

Next to each publication is a link to other publications that cite it. This allows you to immediately determine whether a paper is influential and who it has influenced.

Scholar also includes searches of publications that don’t make it to Medline, like books, small journals, and private collections.

Visits to the nation’s emergency departments (EDs) reached a record high of nearly 114 million in 2003, but the number of EDs decreased by 12 percent from 1993 to 2003, according to a new report released today by the Centers for Disease Control and Prevention (CDC).

The report attributes the rise in ED visits to increased use by adults, especially those 65 years old and over. Among people aged 65-74, the ED visit rate was more than five times higher for those residing in a nursing home or other institution compared with those not living in an institutionalized setting.

The report also finds that Medicaid patients were four times (81 visits per 100 people) more likely to seek treatment from an ED than those with private insurance (22 visits per 100 people).

“Emergency departments are a safety net and often the place of first resort for health care for America’s poor and uninsured,” said Linda McCaig of CDC’s National Center for Health Statistics and the report’s lead author. “This annual study of the nation’s emergency departments is part of a series of surveys of health care in the United States and provides current information for the development of policies and programs designed to meet America’s health care needs.”

Other findings in the report include:

From 1993 through 2003, the number of ED visits increased 26 percent from 90.3 million visits in 1993 to 114 million in 2003. The U.S. population rose 12.3 percent during this period, and the 65-and-over population rose 9.6 percent.

The average waiting time to see a physician was 46.5 minutes, the same as it was in 2000. The wait time was unchanged despite increased visits. EDs have implemented a number of efficiencies, including “fast track” units, which may have kept the wait time constant. On average, patients spent 3.2 hours in the ED, which includes time with the physician as well as other clinical services.

Injury, poisoning, and the adverse effects of medical treatment accounted for over 35 percent of ED visits. The leading causes of injuries were falls, being struck by or striking against objects or persons, and motor vehicle traffic incidents, accounting for 41 percent of injury-related visits. Some 1.7 million visits were for adverse effects of medical treatment.

In 2003, patients arrived at the ED by ambulance in 14 percent of the visits, representing over 16 million ambulance transports. More than a third of patients who arrived at the ED by ambulance was 65 years of age and over.

X-rays, CT scans, or other imaging tests were provided in about 43 percent of visits. Medications were provided in over 77 percent of visits, with painkillers being the most frequent prescription, accounting for just over 14 percent of medications reported.

About 58 percent of all EDs were located in metropolitan areas, and they represented 82 percent of the annual usage. Board-certified emergency medicine physicians were available at 64 percent of EDs.

The CDC report describes hospital, patient, and visit characteristics for hospital emergency departments in the United States as well as trends in ED use between 1993 and 2003. The information is based on data from the 2003 National Hospital Ambulatory Medical Care Survey (NHAMCS) Emergency Department Summary, which is a national probability-based sample survey of visits to emergency and outpatient departments of non-Federal, short stay, and general hospitals in the United States conducted by CDC’s National Center for Health Statistics.

Springfield forges cap on malpracticeSPRINGFIELD — After months of bitter feuding, medical leaders and key Illinois lawmakers from both political parties agreed Wednesday on a plan to cap pain-and-suffering damages in medical malpractice cases.

The hard-fought compromise paved the way for passage of legislation in the next few days. It reflects concerns by Democrats and Republicans alike that the public increasingly blames costly jury awards and expensive malpractice insurance for skyrocketing medical costs and the loss of specialist physicians.

The proposal would set a limit of $1 million on pain-and-suffering awards, also called non-economic damages, from hospitals and a $500,000 limit from doctors.

The cost of medical malpractice insurance appears to cut both ways in Iowa.

Critics say the rising cost of malpractice premiums is driving doctors away from Iowa, but a report by the University of Iowa-based Iowa Physician Information System shows that Iowa has actually gained doctors in recent years.

And for some doctors the reason they come to Iowa is the cost of medical malpractice insurance.

Dr. Jeffrey Piccirillo moved his family and medical practice to the eastern Iowa town of Grinnell where he pays 74-thousand dollars a year in malpractice premiums. He says that’s about one-third of what he paid in suburban Chicago.

The tracking system shows that 264 doctors left Iowa in 2004 for a variety of reasons. It also shows that 303 doctors came to Iowa. That’s a net gain of 39 for a total of nearly five-thousand.

The cost of malpractice insurance doesn’t seem to be tied to the number of lawsuits filed in Iowa.

State records show the number of malpractice lawsuits has dropped since 2002.